Risk Factors & Patho
Osteoporosis is characterized by decreased ____ leading to increased risk of ____
Osteoporosis is characterized by decreased BMD leading to increased risk of fragility fractures
Osteoporosis can be diagnosed with a T score of _____
≤-2.5
Denosumab binds to ____ reducing osteoclast activity and bone resorption
RANK-L
First-line agents for treatment and prevention of osteoporosis due to evidence in preventing spine, hip, and non-vertebral fractures
Bisphosphonates
Adequate supplementation with calcium and Vitamin D is necessary prior to initiation of bisphosphonates to prevent________
hypocalcemia
What cells play a role in bone resorption?
Osteoclasts
What are common locations for fragility fractures?
Spine, hip, and wrist
How often is Denosumab dosed?
Sub Q every 6 months
Efficacy of Romosozumab diminishes after ____
12 months
Peripheral edema is a side effect associated with which anti-resorptive agent(s)?
Denosumab & Raloxifene
True or False: High BMI is a risk factor for osteoporosis
False, low BMI
FRAX tool is used to predict...?
10-year risk of hip fractures and major osteoporotic fractures (spine, forearm, hip, or shoulder)
This hormone analog stimulates osteoblast activity and is used for patients at very high fracture risk, but its use is limited to 18-24 months
Teriparatide (Forteo)
Protein C, S, or antithrombin deficiency is a contraindication to use of ____
Conjugated Estrogens/Bazedoxifene (Duavee)
which bisphosphonate may have better GI tolerability?
Risedronate
How does estrogen deficiency lead to increased bone resorption?
Increased RANK-L expression and osteoclast differentiation
A high fracture risk using the FRAX tool is defined as:
major osteoporotic fracture probability of ≥20% or a 10-year hip fracture probability of ≥3%
Raloxifene is not considered a first line agent due to lack of efficacy in reducing what kind of fractures?
Hip or non-vertebral fractures
After completing Abaloparatide therapy, transitioning to _________ is advised to maintain bone density gains
Bisphosphonates
________ should be avoided in patients with high risk of endometrial cancer, CV disorders, and probable dementia
Conjugated estrogen + bazedoxifene
How does Vitamin D deficiency lead to low BMD?
Decreased calcium reabsorption, up-regulation of PTH and RANK-L expression
You have a 67 year old female patient with primary hyperparathyroidism. How often can you perform a DEXA scan for her billed through Medicare part B?
every 2 years
Maximum duration of therapy with calcitonin is limited to ______ due to increased risk for _______
6 months, Malignancy
Romosozumab inhibits __________ , regulatory factor in bone metabolism that inhibits Wnt/Beta-catenin signaling pathway regulating bone growth
Sclerostin
Black box warning for _____
"SHOULD NOT be initiated in patients with acute CVA in previous year"
Romosozumab